Provider Demographics
NPI:1366457087
Name:TRANSITIONAL LIVING CENTERS, INC.
Entity Type:Organization
Organization Name:TRANSITIONAL LIVING CENTERS, INC.
Other - Org Name:COLUMBIA HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:T
Authorized Official - Last Name:POZDERAC
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-273-5494
Mailing Address - Street 1:6721 GRAFTON ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280
Mailing Address - Country:US
Mailing Address - Phone:330-273-5494
Mailing Address - Fax:330-273-6199
Practice Address - Street 1:6721 GRAFTON ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:VALLEY CITY
Practice Address - State:OH
Practice Address - Zip Code:44280
Practice Address - Country:US
Practice Address - Phone:330-273-5494
Practice Address - Fax:330-273-6199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSITIONAL LIVING CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5210371315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2901640Medicaid
OH36-G476Medicaid